Lung Cancer Diagnosis & Treatment

Diagnosis

Early stage lung cancer often does not have symptoms. In addition, when symptoms appear they can easily be mistaken for common respiratory illnesses like bronchitis or pneumonia. Because of this, many cases are diagnosed at an advanced stage.

Patients at high risk for lung cancer, especially those with a history of smoking, should undergo regular screenings in order to catch the disease at its early stages, when there is a better chance of cure.

If you have symptoms that signal lung cancer, your doctor will ask you questions about your medical, smoking and family history and whether you have been around certain chemicals or substances.

You will then undergo an imaging exam, typically a chest X-ray. Images cannot diagnose lung cancer, but they can show areas of concern. If the image shows such an area, the doctor may order other scans, including a CT scan or PET scan, for additional details regarding the area of concern.

If the findings on the imaging scans indicate cancer, the doctor will request that tissue or fluid be removed from the lung for examination. The act of obtaining a tissue or fluid sample is called a biopsy. There are several ways doctors can perform biopsies of lung tumors:

• Needle biopsy: A CT-guided biopsy where a needle is inserted through the skin under local anesthesia to acquire a tumor sample. One type of needle biopsy is fine needle aspiration (FNA), which uses a very small needle and suction to remove a small amount of tissue.
• Thoracentesis: Fluid from around the lungs is drawn out with a needle and tested for cancer cells.
• Bronchoscopy: A thin, flexible tube with a tiny camera is inserted through the nose or mouth and down into the lungs to obtain a small tissue sample (biopsy). This is usually performed under mild sedation. Bronchoscopies are rarely done alone. Bronchoscopy is usually performed with an endobronchial ultrasound.
• Endobronchial ultrasound (EBUS): A bronchoscope with an attached ultrasound device is used to check for lung cancer inside nearby chest lymph nodes. EBUS is often performed at the same time as a bronchoscopy and requires general anesthesia.
• Video-assisted thoracoscopic surgery (VATS): This minimally invasive surgical procedure uses a small camera to help retrieve tumor samples that are otherwise difficult to access. VATS requires a general anesthetic and is performed in the operating room by a thoracic surgeon.
• Thorascopy/pleuroscopy: A thin, flexible tube with a tiny camera is inserted through a small incision in the back (for a thorascopy) or between the ribs (for a pleuroscopy). Doctors use this device to look for and retrieve suspected cancer tissue.

To complete assessment of how advanced the cancer is, which is called staging, the patient will undergo a PET-CT scan and an MRI or CT scan to check for signs of cancer spread to other organs, including the brain. This will guide the treatment decisions for each patient’s lung cancer.

Treatment

At MD Anderson, some of the nation’s top lung specialists focus their extraordinary expertise on you. We customize your treatment to deliver the most advanced, effective and least invasive treatments available for lung cancer. And because your peace of mind is important to us, we specialize in techniques and therapies than can help preserve lung function and quality of life

We’re constantly researching safer and more effective treatments for lung cancer with fewer side effects. We are proud to be one of the few cancer centers in the nation to house a prestigious federally funded lung cancer SPORE (Specialized Program of Research Excellence) program. This leads to a large number of active clinical trials at MD Anderson and ensures that our patients have access to some of the most cutting-edge therapy anywhere in the world.

If you are diagnosed with lung cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the stage and type of lung cancer; other lung problems, such as emphysema or chronic bronchitis; other prior or current medical conditions; and possible side effects of treatment.

Your treatment for lung cancer will be customized to your particular needs. It may include one or more of the following therapies to treat the cancer and help relieve symptoms.

Surgery

Surgery may be a good option for those with early-stage non-small cell lung cancer. In some cases, patients may receive chemotherapy or radiation before surgery to shrink the tumor. This is called neoadjuvant therapy.

The most common types of surgery for lung cancer, in order of the amount of lung tissue removed, are:

• Wedge resection: Removal of the tumor and a pie- or wedge-shaped piece of the lung around the tumor. This procedure is typically used to perform a biopsy of a lung nodule.
• Segmentectomy or segmental resection: Removal of a segment, or part, of the lobe where the cancer is located. Both the segmentectomy and wedge resection are typically performed on patients who have limited lung capacity and can’t tolerate the removal of a larger section of the lung. They are also a good option for patients with small early-stage tumors generally measuring less than two centimeters. Both preserve lung capacity and the patient’s quality of life.
• Lobectomy: Removal of the lung lobe where the cancer is located. This is considered the “standard of care” for most lung cancer patients who undergo surgery.
• Sleeve lobectomy: A more complex form of lobectomy that is typically used for centrally located tumors. It involves removing the lobe where the tumor is located and part of the connecting bronchus. The cut bronchus is then connected with the remaining lobes. Though not always possible, sleeve lobectomies are preferable to pneumonectomy (complete removal of the lung) in order to preserve more functioning lung tissue.
• Pneumonectomy: Removal of an entire lung. This surgery is occasionally required due to the location of the tumor. In people with lungs that are otherwise healthy and function normally, pneumonectomy is well tolerated.

During most of these procedures, the surgeon will also remove lymph nodes from the chest. Since cancer often spreads through these nodes, doctors will examine them under a microscope to find out if the lung cancer has moved outside the lungs. This will help doctors decide if you need further treatment after surgery, such as chemotherapy, radiation therapy or targeted therapy. Treatment following surgery is called adjuvant therapy.

Surgical approaches

For some lung cancer surgeries, there are different ways to perform the same procedure. Your surgeon will work with you to choose the best option. These methods include:

• Open surgery: The traditional surgical method. Surgeons perform the procedure through a four- to eight-inch incision between the ribs.
• Minimally invasive surgery: These procedures require several smaller incisions, typically between ¼ and ½ inch, and usually have a shorter recovery time and less pain for the patient. There are two primary methods of minimally invasive surgery for lung cancer patients.
  • Video-assisted thoracic surgery (VATS) or thoracoscopy: This technique uses a small camera and instruments that are inserted into the chest allowing the surgeon to perform the surgery through small incisions. It is typically performed on patients with small, early stage lung cancers.
  • Robotic-assisted Surgery: This newer method of minimally invasive surgery uses robotic arms remotely controlled by the surgeon. Better images of the surgical site and greater instrument dexterity allow the surgeon to perform more complex surgery than is possible with VATS.

Statistically speaking, the more experienced the surgeon, the better the outcomes for lung cancer patients. MD Anderson’s Thoracic Center is home to many of the field’s most highly trained, experienced and respected thoracic surgeons. They operate only on cancers involving the chest and use the most advanced surgical techniques to treat a wide variety of lung cancers, including highly complex cases.

All patients with lung cancer who undergo surgery at the Thoracic Center enroll in a program of enhanced recovery, which aims to minimize pain, surgical stress and downtime. This leads to faster recovery, fewer side effects and better quality of life following surgery.

Radiation Therapy

Radiation therapy uses focused, high-energy photon beams to destroy lung cancer cells. It is performed by a radiation oncologist, a specialist who is specially trained to treat cancer with ionizing radiation. At most hospitals, radiation oncologists are expected to treat several different types of cancer. MD Anderson’s Thoracic Center has radiation oncologists dedicated exclusively to caring for patients with lung cancer. This gives them incredibly deep experience in designing treatment plans.

Working with these radiation oncologists is a team of radiation therapy specialists, including dosimetrists and medical physicists. Together, this team of experts develops models for several different treatment types and determines which is best for each patient. This way, MD Anderson can deliver the maximum amount of radiation with the least damage to healthy cells. The radiation therapy treatments used for lung cancer patients include:

• 3D-conformal radiation therapy: Several radiation beams are given in the exact shape of the tumor. This is primarily used as a palliative treatment and not to cure the disease.
• Brachytherapy: Tiny radioactive seeds are placed in the body close to the tumor. Brachytherapy is primarily used to treat metastatic growths in the airway. Since most of these growths can be treated with external beam radiation, brachytherapy is rarely used on lung cancer patients.
• Intensity-modulate radiotherapy (IMRT): Treatment is tailored to the specific shape of the tumor. This type of radiation is commonly used to treat cancers that have invaded nearby lymph nodes.
• Volumetric-modulate Arc therapy (VMAT): This is a special type of IMRT. In it, the part of the machine that shoots out the beam of radiation rotates around the patient in an arc. This can irradiate the tumor more precisely and shorten procedure times.
• Stereotactic body radiation therapy (SBRT): High doses of radiation delivered with several beams at various intensities and angles to precisely target the tumor. Learn more about SBRT.

Proton therapy

A type of radiation therapy, proton therapy delivers a high dose of radiation directly to the tumor, sparing nearby healthy tissue and organs. MD Anderson operates one of the world’s largest and most advanced proton therapy centers. Read more about proton therapy and how it is used to treat lung cancer.

Systemic Therapy

Systemic therapy is an umbrella term for treatments that use substances that travel through the bloodstream to reach affected cells all over the body. There have been significant advances in systemic therapy treatments for lung cancer over the last decades. The medical oncologists at MD Anderson’s Thoracic Center are world-renowned in the care of lung cancer patients and have participated in the clinical trials that have led to the development of important new treatments, including targeted and immune therapies.

Targeted therapy

Cancer cells use specific molecules (often in the form of proteins) to survive, multiply and spread. Targeted therapies stop or slow the growth of cancer by interfering with, or targeting, these molecules. Currently there are targeted therapies for many subtypes of adenocarcinoma. Read more about targeted therapies.

Immunotherapy

Immunotherapies recruit the body’s own immune system in the fight against cancer. The current standard of care for non-small cell lung cancer includes the use of checkpoint inhibitor immunotherapies, which take the natural “brakes” off the immune system, allowing it to attack cancer cells. This treatment can lead to durable responses and has revolutionized care for lung cancer patients. Read more about immunotherapy.

Chemotherapy

Chemotherapy uses drugs to directly kill cancer cells by stopping their growth. This form of treatment is commonly combined with immunotherapy. In combination, both drugs become more effective. Learn more about chemotherapy.

Angiogenesis inhibitors

Angiogenesis is the process of creating new blood vessels. Vascular endothelial growth factor (VEGF) is one of the main molecules that control the process. Some cancerous tumors are very efficient at using these molecules to create new blood vessels, which increases blood supply to the tumor and allows it to grow more rapidly.

Researchers developed drugs called angiogenesis inhibitors, or anti-angiogenic therapy, to disrupt the growth process. These drugs search out and bind themselves to VEGF molecules or receptor proteins, prohibiting them from activating angiogenesis.

Learn more about lung cancer:

• Overview and symptoms
• Diagnosis
• Research

In some cases, lung cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our family history  site to learn more about genetic counseling and testing.